Individual
MATTHEW ALLAN BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14677 MERRILL AVE, FONTANA, CA 92335
(951) 643-2335
Mailing address
9800 MESA LINDA ST APT 178, HESPERIA, CA 92345-0105
(909) 539-3040
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
34542
CA
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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